Erectile Dysfunction in Peripheral Vascular Disease: Endovascular Revascularization as a Potential Therapeutic Target

Abstract

Introduction: Erectile dysfunction (ED) affects more than 150 million men worldwide, with deleterious effects on quality of life. ED is known to be associated with ischemic heart disease but the impact of ED in patients with peripheral arterial disease (PAD) is unknown. We assessed the prevalence and severity of ED in patients with PVD. Methods: Following ethical approval, sequential male patients diagnosed with PAD over a 1-year period following diagnosis of intermittent claudication. The patient demographics and comorbidities were recorded, with the International Index of Erectile Function (IIEF-5) questionnaire used to grade severity of ED. Computed tomographic angiography and severity of stenosis in the proximal vessels and internal pudendal arteries were correlated using a modified Bollinger Matrix scoring system. Results: 60 patients were recruited, most (77.2%) reported erectile dysfunction (52.5% severe, 22.5% moderate). Patients with severe ED were more likely to have 2 or more comorbidities (P = .009). 86.7% with severe ED had bilateral internal pudendal artery stenosis with a mean modified Bollinger score of 17.6. 35.5% of moderate ED patients had bilateral internal pudendal stenosis with a mean Bollinger score of 11.75. There was significant difference in overall scores between moderate and severe erectile dysfunction (p< 0.05), thus indicating a potential link between ED severity and extent of vessel stenosis. Conclusion: There is a substantial burden of clinically significant ED among patients with PAD. This study suggests ED should be discussed with all PAD patients and ED may precede a PAD diagnosis. There is scope for endovascular revascularization as a treatment option for ED secondary to arterial insufficiency.

Serum folic acid levels and erectile dysfunction: A meta‐analysis and systematic review

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Disease-Specific Quality of Life among Patients with Peripheral Artery Disease in Hungary

“…Apparently, younger patients felt more severe limitations in terms of the social relationships caused by PAD as with age, and due to other comorbidities, older people tend to become used to being limited in their social lives. Intimate relationships were the least affected area of life, irrespective of age or disease severity, the majority of our patients reported as having been satisfied with this aspect of their lives, which underlines the importance of the support coming from close relationships with family and friends in coping with a progressive medical condition, especially as positive adaptation showed a considerable decrease in older patients in our study, and worse perceived health status has been shown to be associated with deteriorating mental health [ 50 , 51 ].…”

Pathological Significance of Macrophages in Erectile Dysfunction Including Peyronie’s Disease

“…As mentioned above, ED is recognized as a vascular disease. In fact, various vascular diseases, such as atherosclerosis, coronary heart disease, and peripheral artery disease, are known to cause ED because endothelial damage and subsequent atherosclerotic plaque formation are common etiologies of ED and other vascular diseases [ 24 , 25 ]. Lipid metabolism abnormalities and monocyte/macrophage activity are reported to be crucial factors in the relevant pathological steps, including atherosclerotic plaque formation [ 26 , 27 , 28 , 29 , 30 ].…”